眶周穿支皮瓣联合耳软骨及口腔黏膜修复全层眼睑缺损

Reconstruction of full-thickness eyelid defect using peri-orbital perforator flap combined with auricular cartilage and oral mucosa

目的探讨眶周穿支皮瓣联合耳软骨及口腔黏膜修复重度眼睑全层缺损的手术方法及疗效。方法选取大于睑裂2/3的重度眼睑全层缺损患者11例,以眶周"毛细"穿支血管为基础制备穿支皮瓣修复眼睑前层软组织,切取耳软骨及口腔黏膜复合移植修复眼睑后层替代睑板及结膜,观察再造眼睑功能及外观。结果本组共11例患者。除1例皮瓣远端出现静脉危象,治疗后缓解;2例睑缘出现软骨暴露,经简单处置后自行愈合外;其余再造眼睑成活良好,满足功能及美观要求。结论眶周穿支皮瓣设计灵活,血供稳定,联合耳软骨及口腔黏膜再造眼睑,功能良好,外观满意。

Objective To explore the surgical method and curative effect of composite grafting of the peri-orbital perforator flap combined with auricular cartilage and oral mucosa in the reconstruction of full-thickness eyelid defects. Methods A total of 11 patients with severe full-thickness eyelid defects more than 2/3 of the full length were included in this study. Peri-orbital perforator flaps based on capillary perforator vessels were used to reconstruct the anterior soft tissue of the eyelids. Auricular cartilage and oral mucosa were used to repair the posterior layer of the eyelids, substituting tarsal plates and conjunctivas. The function and appearance of the reconstituted eyelids were observed. Results Of the eleven cases, venous congestion of the partial flap occurred in one patientand healed after treatment. In two other patients, exposure of the cartilage at the eyelid margin occurred and healed after simple treatment. All other reconstructed eyelids survived well. Conclusion Peri-orbital perforator flaps with abundant blood supplyare easy to transfer and can obtain a good functional and aesthetic outcome in the reconstruction of full-thickness eyelid defects, when combined with auricular cartilage and oral mucosa.